Summary
The aim of this study is to suggest an anatomic study of the modifications of the length of the anterior cruciate ligament (ACL) and its bundles during flexion with the aid of a 3D computerized model of the knee in a living subject. The method of evaluation suggested is a 3D computerized reconstruction based on MRI sections, reproducing the movement of flexion of the knee from 0 to 75°. Twenty-one sections were made for each of the 13 positions of flexion. The reconstruction of Delaunay and the realignment of each position provided a 3D model which allowed monitoring of a bony point during the movement. By knowing the relative displacement of the ligamentous attachments it was possible to define the biometry of the ligament by calculating the length of the bundles of the ACL in each position and to demonstrate the variations in length during the movement. The mean length of the ligament was 3.4 mm. The anteromedial bundle was longer by 30% compared with the other two bundles. During flexion the anteromedial bundle was not much modified (this feature seems to provide a reference position for a ligamentoplasty), the posterolateral bundle became taut after 30°, and the intermediate bundle relaxed from the beginning of movement. Based on the data from the literature, this method allows an anatomic approach to the ACL, bundle by bundle, during flexion movement.
Résumé
Ce travail a pour but de proposer à l'aide d'un modèle informatique 3D du genou chez un sujet vivant une étude anatomique des modifications de longueur du ligament croisé antérieur (LCA) et de ses faisceaux au cours de la flexion. La méthode d'évaluation proposée est une reconstruction informatique 3D, à partir de coupes IRM, reproduisant le mouvement de flexion du genou de 0 à 75°. Vingt-et-une coupes ont été réalisées pour chacune des 13 positions de flexion. La reconstruction de Delaunay et le recalage de chaque position permettent d'obtenir un modèle 3D. Ce modèle permet le suivi d'un point osseux lors du mouvement. En connaissant le déplacement relatif des insertions ligamentaires, il est possible de préciser la biométrie du ligament en calculant la longueur des faisceaux du LCA à chaque position, de mettre en évidence les variations de longueur au cours du mouvement. La longueur moyenne du ligament était de 34 mm. Le faisceau antéro-médial était plus long de 30 % par rapport aux deux autres faisceaux. Lors de la flexion, le faisceau antéro-médial était peu modifié (cette caractéristique semblait en faire une position de référence pour une ligamentoplastie), le faisceau postéro-latéral se tendait à partir de 30°, le faisceau intermédiaire se détendait dès le début du mouvement. En retrouvant les données de la littérature, cette méthode permet une approche anatomique du LCA faisceau par faisceau lors du mouvement de flexion.
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Boisgard, S., Levai, J.P., Geiger, B. et al. Study of the variations in length of the anterior cruciate ligament during flexion of the knee: use of a 3D model reconstructed from MRI sections. Surg Radiol Anat 21, 313–317 (1999). https://doi.org/10.1007/BF01631331
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DOI: https://doi.org/10.1007/BF01631331